*Note to Mods: No, I’m not planning on starting a home business. *
This first couple pages of this thread got me thinking…
I think it’s pretty much accepted, particularly among the pro-choice community, that a ban on abortion would hardly curtail it, if at all, but simply force it underground. Coat hangers in back alleys, and all that.
That said, having actually thought about it for the first time, it occurs to me that other illegal medical procedures (steroid/HGH therapy, organ harvesting) are usually performed by medical professionals, rather than Joe Scalpel, and under relatively sanitary conditions.
Which leads to my questions: how safe would an “underground” abortion clinic be? What sort of equipment and personnel would you need, and how much would they cost?
I imagine the greatest increase in risk would come from unscrupulous (and unlicensed) providers having no incentive to say, “in your case, the procedure would be dangerous.” Correct?
An abortion is not hard. A safe abortion is a little harder. There’s a tricky angle of approach - many coathanger abortions end(ed) up perforating (puncturing) the uterus because there’s a change in the angle after the vagina, and if you just keep pushing back, you’ll punch through the uterine wall. This is, I probably need not say, not good.
Gaining access to clean and up to date medical equipment without a license is even more difficult, and finding a landlord to rent a clean space accessible to low income women and within a short ambulance ride of a hospital (in case of bleed-outs) to perform illegal surgeries in would be, I expect, harder yet.
Honestly, I think if abortion is made illegal, we won’t be back to coathangers and turtleshells so much as seeing a huge blackmarket for abortifacient drugs and herbs - and for herbs, at least, there is no such thing as a safe abortifacient. Herbal abortifacients work by the “make the mother so sick her uterus thinks she’s dying and expels the uterine contents in a last ditch effort to save the mother” principle. It’s a very fine line between a successful abortion and a dead mother, and I’m not comfortable with the thinness of that line. Additionally, many abortifacient herbs cause birth defects if they don’t cause abortions, so I would never advocate herbal abortions when surgical is not available as a backup. That doesn’t stop women from asking me for them on a regular basis. (I always say no, it’s not worth the risk when Planned Parenthood can help you out much more safely on a sliding scale.)
When the South Dakota abortion ban was in the news, numerous websites cropped up that contained supply and equipment lists and very explicit instructions for performing abortions. If you google “do it yourself abortion,” you’ll find a number of those sites. Despite the name, the instructions were not designed to enable women to perform abortions on themselves but rather to assist organizations that wanted to establish “guerilla” abortion clinics.
Frankly, it’s quite a simple procedure, in the early stages of gestation. It’s basically a dilation and curettage procedure (done very commonly on non-pregnant women with dysfunctional uterine bleeding among other things) performed during the first trimester of pregnancy.
Most med students pick up the ability to do that procedure pretty quickly, if they do the gyn rotation. Or did, back when I trained.
A long time ago, didn’t they perform illegal abortions by injecting some liquid into the uterus? I don’t know what it was, and I think it wasn’t very safe. I shudder to think on it.
There’s a procedure that can be done after 16 weeks called saline amniocentesis, where some of the amniotic fluid is taken out and replaced with saline. The saline kills the fetus and then usually the woman goes into labor spontaneously within the next day or so and delivers the dead infant. Sometimes she doesn’t go into labor on her own and they have to induce labor with drugs.
Apparently filling the uterus with soapy water was a favored method in the 30’s. Relatively easy, low equipment and consumables cost (a bowl and some narrow tubing or a large syringe), but very high risk of undesired consequences (ie, death). (I’ve seen some people claiming the fatality rate with this method was essentially 100%, which if true shows how desperate the women must have been.)
That is the method portrayed in the 2004 UK movie Vera Drake.The claim that that particular method is both incredible painful, and 100 % fatal, is supported by this Guardian article.
Look, I don’t want to send this thread into GD territory here, but I’m having a hard time wrapping my mind around this.
If an ob/gyn performs abortions in her practice, and abortion is then banned, in a practical (notice I didn’t say “legal” or “ethical”) sense, what’s to stop her from continuing?
My thinking is that if Roe v. Wade is overturned, illegal abortions won’t be the “back alley” type so much as the “ob/gyn doing it anyway, in her office under sterile conditions” type.
Perhaps the question implies “How would anyone know?” I’m guessing the word would simply get out, plus there might be some unusually large amounts of medical waste to explain.
I seem to recall that in the bad old days some illegal practitioners simply started the procedure, and then told the woman to go to a motel room somewhere until it was over. Or told them to go home for a while and then go to a hospital and try to convince people it was spontaneous.
Sure. There’s always staff that can leak information, even with the best of intentions. I assume there’d be word of mouth, as women shared information about abortion providers in their area - in today’s world, probably websites that would be set up, and ISP numbers tracked when the police got wind of it.
Heck, nowadays barely anything is autoclaved for reuse, it’s almost all one use disposable stuff - how are you, the gynecologist, going to explain your larger-than-expected orders of D&C kits for a healthy, non-pregnant clientele? How do you track the procedures, rooms used, materials used and staff paid for procedures you’re “not performing”? How do you account for the money taken in, even assuming you insist on cash payment and not insurance?
I just don’t see how it’s possible, given today’s computerized everything, for any meaningful amount of abortions to be performed in secret yet in a practicing doctor’s office.
I suppose it might be possible for some clients to suddenly need a D&C - that is, the same procedure (essentially) can be used to abort an early term fetus and to treat endometriosis, so a doctor could lie and claim the patient needs a D&C for some reason other than terminating a pregnancy. But to do that means you then have to have a diagnosis code of endo (or something), which will go on her record. Assuming she doesn’t have that condition, she now has erroneous medical information in her file, which could mean misdiagnosis or mistreatment of conditions down the road, or simply a preexisting condition making insurance prohibitively expensive or impossible to get. And what a position for the doctor to be in! Get one of these hysterical regretters, and now you’re going to get sued for malpractice, not just for performing an illegal abortion, but for intentionally misdiagnosing and falsifying medical records! Doesn’t sound like a good career move to me.
The problem is more that women will be less inclined to seek medical assistance from complications arising from abortion if it’s made illegal. Initially minor bleeding or infection is allowed to develop into something life threatening because they didn’t seek treatment out of fear of legal repercussions. Regardless of the conditions under which the abortion itself is actually performed.
Inducing miscarriage isn’t that difficult. Doing it safely with no follow-up? Not so much.
Whynot- endometriosis is not treated by D&C, as endometriosis is symptomatic because of uterine tissue outside the womb, but a D&C only removes the lining and contents of the womb.
A D&C is a diagnostic procedure as well as a treatment so you could code it as an investigation for irregular or heavy periods, but yes, not ethically or legally smart. You wouldn’t really want to do a D&C on a conscious person. Most early surgical terminations are done by vacuum aspiration, which require a very simple piece of kit.
I think one thing a doctor could do would be to diagnose a “missed miscarriage”- that is where the foetus has died by the uterus has not started to expel it yet, it is diagnosed by absent foetal heartbeat on ultrasound scan. The treatment of a missed miscarriage is a D&C (or evacuation of retained products of conception, as it is known in such cases) or medical induction of a miscarriage, depending on the stage of pregnancy and the wishes of the woman. Unless anyone were to actually see a foetal heartbeat on an ultrasound scan prior to the procedure, no one would know any differently, and the woman could always refuse further scans as being “too traumatic”.
Medical termination can be performed at any stage of pregnancy, except between 9 and 12 weeks, when surgical options are preferred. Medical terminations use drugs like Misoprostol or agar laminaria to dilate the cervix and start contractions, essentially inducing labour. If a woman presented after the cervix had started to open and bleeding and cramping had started, it would be almost impossible to determine whether she was having a miscarriage or not, and nothing could be done to stop the process.
The procedure for a ERPOC for missed miscarriage is identical to the procedure for a TOP by D&C. Inducing medical TOP/induction for missed miscarriage requires no special skills. The important thing would be follow-up and safety-netting- a proportion of women who have medical induction will bleed extremely heavily and require D&C to complete the process safely, many will also require strong prescription pain relief and all need monitoring for infection.
Really? My mum had several D&C’s a year because of her endo/fibroids/cysts issues before finally a cyst up on the ovary ruptured and they did a total hysterectomy (and ovary-ectomy, I forget the technical term). Maybe the D&C wasn’t for the endo per se, but for part of the whole, “gadzooks, woman, there’s tissue growing *everywhere *up there!” package.